Mid-Term Outcomes of Heart Transplants from HCV NAT+ Donors.

The advent of direct acting antivirals has allowed for utilization of HCV NAT+ donors with good short-term outcomes. The goal of this study was to compare clinical outcomes among heart transplant recipients who received hearts from HCV NAT+ donors to those from NAT- donors. We examined the UNOS registry of all primary orthotopic adult heart transplants from March 15, 2015 to August 31, 2021 and identified their donors as HCV NAT+ or NAT-. Those with multiorgan transplants or waitlisted for other organs were excluded. Baseline characteristics, three-year survival, and treatment for rejection at one year were compared between the two groups. Of 16,491 heart transplants meeting study criteria, 729(4%) hearts came from HCV NAT+ donors. HCV NAT+ donors were older (34±8 vs 32±11 years, p<0.01), more likely males(75% vs 70%, p<0.01), white race(83% vs 63%, p<0.01), and blood group O(60% vs 50%, p<0.01). They were more likely to have drug use as cause of death(59% vs 18%, p<0.01) and classified as CDC high risk (87% vs 29%, p<0.01). Recipients were more likely blood group O(48% vs 39%, p<0.01) and have positive hepatitis C serologies(5% vs 2%, p<0.01). They were less likely Status 1A (58% vs 67%, p<0.01) or Status 1 (4% vs 9%, p<0.01) or 2 (36% vs 48%, p<0.01). Distance traveled (241 vs 139 nautical miles, p<0.01) and ischemia times (3.48 vs 3.23 hours, p<0.01) were greater in the HCV NAT+ group, while wait list duration was similar (69 vs 69 days, p=0.20). Three-year survival (87% vs 85%,Figure; log-rank p=0.26) and treatment for rejection in first year post transplant (19% vs 18%, p=0.72) were not significantly different between the two groups. HCV NAT+ donors are being increasingly used for heart transplantation, particularly for lower status recipients with otherwise longer wait times. Three-year survival and treatment for rejection at one year are comparable to those from HCV NAT- donors. Therefore, HCV NAT+ donor hearts should continue to be utilized with monitoring of long-term outcomes. [ABSTRACT FROM AUTHOR]